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Breast Augmentation
Surgery
Before you sign up for breast augmentation
surgery, you and your plastic surgeon must take time to consider the
following choices
Position
(under or over the muscle)
By implant position, plastic surgeons are referring to whether the breast
implant should be placed above or below the pectoralis muscle. Advantages
for placing the breast implant above the muscle include less discomfort
post-operatively, less swelling, and less chance that the breast will
appear to move when you are exercising your upper body. This last issue
has been one of great concern for many women, especially those who have
full workout regimes. Simply put, if your breast implants are under the
muscle, then when you flex your pectoralis muscles (as you often do during
workouts), your breasts may appear to move. Sometimes (though not commonly)
the breast motion will appear quite distorted. Now, to bring things into
perspective, you should realize that many women who work out (and even
some professional female athletes) have implants under the muscle and
are very happy with their appearance. In other words, if you work out
a lot, do not automatically believe that your breast implants need to
go over the muscle. Advantages for placing the implants under the muscle
include less interference with mammography and less rippling in the upper
half of the breast. Generally, thin and small-breasted women should favor
implant placement under the muscle. The advantages of less interference
with mammography, less rippling of the upper half of the breast, and more
cushion between the implant and the skin outweigh the drawbacks, many
of which are temporary. Athletic women should consider placement of the
implant above the muscle (as long as they have adequate breast tissue
and body fat) to avoid breast distortion when the pectoral muscles are
flexed. Thin, small-breasted, athletic women must weigh the options. In
general, they are probably better off with implants under the muscle.
Even though this can cause distortion of the breast while working out,
this is not too much of a problem unless you work out in the nude. A more
significant cosmetic problem for these women is rippling, which is less
likely to occur in the upper half of the breast if the implants are placed
under the muscle. Of course, this is your call. Be sure to discuss it
carefully with your plastic surgeon. An alternative for these women is
to have silicone breast implants. Read more about the under/over decision
of breast implant placement.
2. Breast Implant surface (textured or smooth)
By implant surface, plastic surgeons are referring to whether the implant
is smooth or textured. A smooth implant is just that – as smooth as the
surface of a balloon. Textured implants are rough, somewhat like sandpaper.
Once they are in placed under your breasts, it is impossible to tell whether
you have smooth or textured implants. Textured implants were developed
because plastic surgeons thought that they would be less likely to cause
capsular contractures. Unfortunately, studies have not shown a consistent
advantage of textured implants over smooth when it comes to capsular contractures.
Also, textured implants are more likely to cause rippling, which can be
a big problem for thin and small-breasted women. For these reasons, most
plastic surgeons favor smooth implants for breast enlargement. Read more
about the decision about breast implant surface.
Shape (round or teardrop)
By this, plastic surgeons are referring to round or teardrop shape. Round
implants are shaped like jelly donuts. Teardrop implants are shaped more
like the breast. At first, you might be thinking that (of course) teardrop
implants would be better. However, most plastic surgeons disagree: they
think that teardrop implants tend to become round with the forces of healing
and that the teardrop implants do not necessarily give a better result.
Furthermore, they find that teardrop implants may rotate, giving an unnatural
appearance, and they impose restrictions in that they must be textured.
Because plastic surgeons tend to recommend the techniques that work best
in their hands, you should heed the advice of your plastic surgeon in
this matter. Read more about the decision of breast implant shape.
Size
This is the all-important size issue. Breast implants come in all sizes
with the most common sizes ranging from 200-600 cc. This is equivalent
to 7-20 ounces. Within that range, 300-450cc is probably the most common
of the breast implant size. By the way, a cc (cubic centimeter) is the
same as a ml (milliliter) – just in case you have visited other sites
which refer to volumes in mls. This decision is highly personal and highly
individualized. The best way to determine your size is by placing breast
implant sizers (your plastic surgeon will hopefully have them) in your
bra and then put a sweater, blouse, or t-shirt on (or, perhaps try all
of them, as you will appear different in each). Do not allow your surgeon
to dictate your size. You must have input in this decision. Read more
about the decision of breast size selection.
Also, please check out this down-loadable pdf file: Implant Volume, Diameter,
and Projection, which shows the specifications of all moderate and high
profile implants (both saline and silicone) made by one of the major implant
manufacturers. All implant manufacturers make similarly shaped implants
with similar specifications.
Breast Implant projection
(standard vs. high profile)
Breast implants are designed so that, as volume increases, so does diameter
(the footprint of the implant) and projection (the amount it sticks out,
away from your body). Standard implants are designed so that MOST women
who choose a given volume will be able to accommodate the breast implant’s
diameter beneath her breasts. This is so because women with narrower breast
diameters often have smaller bodies and tend to choose smaller breast
implants; women with wider breast diameters often have larger body frames
and tend to choose larger breast implants. In other words, women tend
naturally to choose an implant volume that is in proportion with body
size and breast diameter, and the breast implants were designed in anticipation
of that. BUT, what if a woman wants the breast implant size to be that
which has a larger volume than would be considered proportionate (by breast
implant manufacturer standards) for her breast diameter, chest wall size,
and body frame? In that case, placing a standard implant would risk an
unnatural result, because it would be too wide for her body frame and
would likely also extend too high and too low on her chest wall. In these
cases, a High Profile implant is recommended. With a high profile implant,
the volume is the same, but the diameter (footprint) is narrower and the
projection (the amount that it sticks out away from your body) is greater.
Most women (over 95%) are best suited to standard implants. The way to
tell if you should have standard implants or high-profile is as follows:
First, your surgeon should measure your breast diameter. Next, you should
choose the implant volume that you want. Finally, your surgeon should
compare the diameter of the desired implant size (standard implant) to
the measured diameter of your breast. If the diameter of the breast implant
size you selected is about the same or smaller than your measured breast
diameter, then a standard implant is appropriate. If the diameter of the
desired breast implant is larger than you breast diameter, then you should
consider high profile breast implants. Read more about the decision of
implant profile and projection.
Saline Vs. Silicone Gel
On 11/17/06, the FDA approved silicone gel breast implants for use in
primary breast augmentation for any woman over the age of 22. This approval
is expected to result in a large number of women seeking silicone breast
augmentation.
Silicone breast implants provide a more natural look and feel, which is
particularly important to women who have a modest amount of breast tissue.
Although all women want a natural look and feel, women with larger breasts
can often achieve this with saline implants. Women with smaller breasts
typically cannot. The main disadvantage of silicone gel breast implants
is that they might have a higher rate of capsular contracture, the incision
is usually longer, and the cost is higher than saline breast implants.
Read more about the decision of saline implants or silicone gel implants.
Fill
(This Pertains only to Saline
Implants, as Silicone implants are Pre-filled by the Manufacturers)
Saline implants come in increments of about one ounce, which is 30 cc.
Mcghan implants are made in 30cc increments (180cc, 210cc, 240cc, 270cc,
300cc, etc.). Mentor Implants are made in increments of 25cc (200cc, 225cc,
250cc, 275cc, etc.). Each saline breast implant can be and SHOULD BE overfilled
by an additional 25-30 cc. This is because the implants were meant to
be overfilled, and the implant manufacturers not only stand by their products
when they are overfilled, but they encourage plastic surgeons to overfill
them. Here’s why: overfilling reduces deflation, rippling, and sloshing.
Underfilling has no advantages and significant disadvantages (rippling,
sloshing, and deflation). So, after you select your desired final volume,
your plastic surgeon should select an implant that is one size smaller,
and then overfill it to your desired volume. Read more about the decision
of breast implant fill.
Site of Incision
The options for site of incision are under your breast, around your nipple,
in your armpit, or through your belly button. An incision under the breast
is placed within or near the natural crease beneath your breast. This
incision has the advantage of having the scar hidden in the shadow of
the crease under the breast. It also heals well. It also is the incision
you would likely get anyway if you require revision surgery later in life.
Most plastic surgeons use this incision. Around the nipple can give a
good result in some women, but is riskier because it is at the focal point
of the breast, so any irregularities in the scar will make it far more
obvious. It also imposes a higher risk of nipple numbness and inability
to breastfeed. Under the arm is an option and has the advantage of being
hidden in the armpit. Although many of these scars heal favorably, some
armpit (axillary) incisions can be unsightly. Also, revision surgery,
if needed, might not be possible through the existing armpit scar, so
an additional scar would be necessary. Finally, the incision for your
breast augmentation can be made through the belly button. This is called
TUBA, or Trans-Umbilical Breast Augmentation. The advantage is that the
incision is hidden inside the belly button. The disadvantages are that
the implant must be placed in the subglandular plane (over the muscle),
the surgeon may not be able to correct certain breast asymmetries, the
deflation rate may be higher, and revision surgery through the original
scar is not possible, so an additional scar would be necessary (around
the nipple or under the breast). For all of these reasons, few surgeons
perform this incision when placing breast implants. Read more about scars
and site of incision.
Breasts of Different Sizes
Most women have breasts that are different from one another in size, shape,
and position. But, what are the options if the breasts are more than just
a little different? Read more about breast asymmetry.
To Lift or Not to Lift?
Whereas a breast augmentation will increase breast size, it will not affect
nipple position and will not raise a droopy breast. Simply put, implants
will make you bigger but will not raise your nipples. A breast lift will
raise your nipples but will not affect your size. Find out if you should
be considering a breast lift and what the options are.
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